What are the health benefits and risks of fluoride?

Fluoride is present to some degree in all water sources, foods and beverages. Fluoride helps to prevent cavities when used in two ways: topically and systemically. Topical (on the surface) application of fluoride occurs with the use of fluoride containing toothpaste, mouthrinses, professionally applied gels, foams, rinses, and from our own saliva. Topical use of fluoride helps to prevent cavities by strengthening the surface of the teeth (the enamel), reducing the ability of bacteria contained in dental plaque to produce acid, and by re-mineralizing existing dental cavities. Fluoride can actually heal small cavities in some cases, and prevent the need for dental fillings.

Systemically (throughout the body), fluoride is obtained when ingested via water and other beverages, foods, drops, tablets, and other sources. A major function of fluoride taken systemically is the strengthening of developing teeth from infancy to adolescence. Fluoride strengthens teeth by the formation of harder enamel(hydroxyapatite crystals are converted to fluorapatite) that is less vulnerable to damage from plaque acids. Fluoride that is taken systemically is helpful to adults and seniors because it is a component of saliva, where it provides topical protection against cavities.

Mass water fluoridation (addition of fluoride to community water supplies) is the most cost-effective measure available to reduce the incidence of tooth decay. The Environmental Protection Agency has determined that the acceptable tap water concentration for fluoride is 0.7 to 1.2 parts per million (Much higher levels have been associated with chalky white discolorations of the teeth known as fluorosis). Numerous studies in the United States and around the world have proven that fluoridated water at these levels reduces the incidence of cavities in children and adults from 25-60% or more.

Some people worry about the safety of fluoride in drinking water. Research has demonstrated that fluoridated water that occurs naturally, or is adjusted to optimal levels 0.7 ppm by adding it to the water supply, has no adverse health consequences. After fluoride is ingested, about half of it is removed through the kidneys, and nearly all of the remaining is deposited in the bones and teeth (from infancy to adolescence).

Hydroxide ions in calcium hydroxyapatite of the teeth, which protect against cavities, are replaced by fluoride ions from water or toothpaste. The resulting chemical is calcium fluoroapatite. This chemical has a lower pH and is considered to be more stable and consequently, fewer cavities are thought to result. From a public health perspective, water fluoridation is encouraged because it is thought to decrease the likelihood of development of cavities, especially in children who do not receive routine dental care.

Anecdotal evidence has associated the consumption of fluoridated water with impaired thyroid function, weakened bones, neurotoxicity and bone cancer in boys. Opponents claim that the possible risks posed to communities consuming fluoride outweighs the potential benefits.

Published evidence of toxicity due to fluoride pertains to industrial accidents and mechanical error. For instance, in 2002, seven children experienced nausea and vomiting after an electrical circuit that energized a school fluoride system deposited too much of the chemical in the water system due to error.

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